Cuidados prenatales asociados a los resultados neonatales en maternidades: un estudio transversal hospitalario

Vidal, Eglídia Carla Figueirêdo; Oliveira, Lara Leite de; Oliveira, Camila Almeida Neves de; Balsells, Marianne Maia Dutra; Barros, Maria Aline Rodrigues; Vidal, Emery Ciana Figueirêdo; Pinheiro, Ana Karina Bezerra; Aquino, Priscila de Souza

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Revista da Escola de Enfermagem da USP

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0145en copiar

Cuidados prenatales asociados a los resultados neonatales en maternidades: un estudio transversal hospitalario

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Verificar la asociación entre los indicadores de calidad de la atención prenatal y los resultados neonatales en las maternidades.

Método:

Estudio transversal de base hospitalaria en cuatro maternidades de referencia de alto riesgo en las cinco macrorregiones sanitarias autorizadas por la Red Cigüeña en Ceará-Brasil. Entre abril de 2017 y julio de 2018, se entrevistaron 440 puérperas mediante muestreo probabilístico simple y fórmula con poblaciones finitas y estratificación de cada maternidad. El análisis involucró Chi-Cuadrado de Pearson, Análisis de Residuos Ajustados y Exacto de Fisher.

Resultados:

Hubo asociación entre menor número de consultas con prematuridad y bajo peso al nacer. El parto en el hospital de maternidad donde vivía la mujer se asoció con el bajo peso al nacer y la necesidad de asistencia ventilatoria.

Conclusión:

Los indicadores de calidad de la atención prenatal influyeron en los resultados neonatales, lo que subraya la importancia de garantizar el acceso y la calidad de la atención como formas de reducir la morbimortalidad infantil.

DESCRIPTORS
Atención Prenatal; Salud Materno-Infantil; Enfermería; Obstetricia; Servicios de Salud Materna

Variables for PN care	Macro region					p-value*
Variables for PN care	Cariri n (%)	Fortaleza n (%)	Sertão central n (%)	Sobral n (%)	Ceará n (%)	p-value*
Start of PN
Up to 12 weeks	40 (80%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	90 (50.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	46 (59.7%)	80 (59.7%)	256 (58.2%)	0.002
Over 12 weeks	10 (20%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	89 (49.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	31 (40.3%)	54 (40.3%)	184 (41.8%)
Number of PN visits
Up to 6	10 (20.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	77 (52.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	24 (31.2%)	35 (27.5%)	146 (34.1%)	0.002
7 or more	39 (79.6%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	98 (34.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	53 (68.8%)	92 (72.4%)	282 (65.9%)
Vaccines during pregnancy
Yes	50 (100%)	168 (96%)	68 (90.7%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	130 (99.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	416 (96.5%)	0.006
No	0 (0%)	7 (4%)	7 (9.3%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	1 (0.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	15 (3.5%)
HIV tests during pregnancy
Yes	48(96%)	157(90.2%)	65(87.8%)	119(90.8%)	389(90.7%)	0.489
No	2(4%)	17(9.8%)	9(12.2%)	12(9.2%)	40(9.3%)
Tests for syphilis in pregnancy
Yes	47(94%)	154(86.5%)	70(90.9%)	104(78.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	375(85.8%)	0.020
No	3(6%)	24(13.5%)	7(9.1%)	28(21.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	62(14.2%)
Professional who carried out the PN
Both	41(83.7%)	128(74.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	62(83.8%)	113(86.3%)	344(80.7%)	0.004
Nurse	3(6.1%)	15(8.7%)	6(8.1%)	15(11.5%)	39(9.1%)
Physician	5(10.2%)	29(16.9%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	6(8.1%)	3(2.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	43(10.2%)
Complications during pregnancy
Yes	9 (18%)	36 (49.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	18 (24.7%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	4 (3.1%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	67 (15.5%)	<0.001
No	41 (82%)	142 (79.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	55 (75.3%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	127 (96.9%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	365 (84.5%)
Risk stratification at admission
High risk	6 (12%)	27 (15.1%)	15 (19.5%)	17 (12.7%)	65(14.7%)	0.544
Normal risk	44 (88%)	152 (84.9%)	62 (80.5%)	117 (87.3%)	375(85.3%)
Delivery at municipality of residence
Yes	21(42%)	133(74.3%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	33(43.4%)	44(32.8%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	231(52.6%)	<0.001
No	29(58%)	46(25.7%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	43(56.6%)	90(67.2%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	208(47.4%)
Prematurity (<37 weeks)
Yes	9(18%)	35(21.1%)	7(9.9%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	27(21.3%)	78(18.8%)	0.187
No	41(82%)	131(78.9%)	64(90.1%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	100(78.7%)	336(81.2%)
Low birth weight (<2500g)
Yes	4(8%)	24(14.5%)	9(11.7%)	25(18.8%)	62(14.1%)	0.222
No	46(92%)	155(85.5%)	68(88.3%)	108(81.2%)	377(85.9%)
1st minute Apgar
Up to 7	5(11.4%)	28(15.7%)	3(4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	23(17.6%)	59(13.8%)	0.039
Over 7	39(88.6%)	150(84.3%)	72(96%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	108(82.4%)	369(86.2%)
5th minute Apgar
Up to 7	3(6.8%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	2(1.1%)	1(1.4%)	3(2.3%)	9(2.1%)	0.122
Over 7	41(93.2%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	176(98.9%)	73(98.6%)	129(97.7%)	419(97.9%)
Ventilatory support for NB after birth
Yes	5(10%)	16(8.9%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	7(9.1%)	29(21.6%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	57(12.9%)	0.005
No	45(90%)	163(91.1%)⁽⁺⁾ *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	70(90.9%)	105(78.4%)^(⁻) *Pearson Chi Square; (+) Significant positive association; (⁻) Significant negative association.	383(87.1%)
Immediate neonatal resuscitation
Yes	1(2%)	3(1.7%)	0(0%)	4(3%)	8(1.8%)	0.479
No	49(98%)	176(98.3%)	77(100%)	130(97%)	432(98.2%)

	Prematurity			Low weight			1st minute Apgar ≤ 7			5th minute Apgar ≤ 7			Ventilatory support			Neonatal resuscitation
	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-value	Yes	%	p-valor
Start of PN
More than 12 weeks	31	17.9	0.685^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	24	13.1	0.608^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	26	14.5	0.706^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	1.7	0.740^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	25	13.6	0.738^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	1.6	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Up to 12 weeks	47	19.5		38	14.8		33	13.3		6	2.4		32	12.5		5	2
PR/CI 95%	0.91 [0.610-1.384]			0.884 [0.550-1.420]			1.096 [0.680-1.765]			0.69 [0.176-2.744]			0.92 [0.565-1.498]			0.83 [0.202-3.449]
Pregnancy complications
Yes	12	19.4	0.759^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	11.9	0.610^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	11	16.9	0.423^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	1.6	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	5	7.5	0.159^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	0	0	0.616^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
No	61	17.7		52	14.3		47	13.2		8	2.2		50	13.7		8	2.2
PR /CI 95%	1.091 [0.625-1.905]			0.83 [0.416-1.679]			1.282 [0.703-2.338]			0.697 [0.089-5.480]			1.83 [0.760-4.433]			1.022 [1.007-1.038]
Number of PN visits
Up to 6	39	28.3	<0.001*	33	22.6	<0.001*	18	12.8	0.701^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	1.4	0.722^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	22	15.1	0.184^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	1.4	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
7 or more	37	13.8		27	9.6		39	14.1		6	2.2		30	10.6		5	1.8
PR /CI 95%	2.04 [1.372-3.054]			2.35 [1.474-3.755]			0.903 [0.537-1.520]			0.650 [0.133-3.180]			1.41 [0.848-2.365]			0.77 [0.152-3.934]
Vaccines during pregnancy
No	4	33.3	0.244^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	20	0.444^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	7.1	0.703^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	7.1	0.265^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	6.7	0.705^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	0	0	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	70	17.8		56	13.5		57	14		8	2		54	13		8	1.9
PR /CI 95%	1.87 [0.818-4.283]			1.48 [0.523-4.198]			0.509 [0.076-3.415]			3.62 [0.486-27.039]			1.94 [0.288-13.146]			1.02 [1.006-1.033]
HIV tests during pregnancy
No	8	21.6	0.531^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	20	0.252^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	7.5	0.220^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	2.5	0.599^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	5	0.120^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	1	2.5	0.546^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	64	17.5		52	13.4		55	14.6		8	2.1		53	13.6		7	1.8
PR /CI 95%	1.23 [0.644-2.375]			1.49 [0.764-2.915]			0.515 [0.169-1.573]			1.18 [0.152-9.205]			0.36 [0.093-1.450]			1.38 [0.175-11.008]
Tests for syphilis in pregnancy
No	13	22.4	0.438^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	8	12.9	0.790^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	7	11.3	0.559^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	4.8	0.130^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	3	4.8	0.043^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	3.2	0.317^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Yes	64	18.1		53	14.2		51	14		6	1.7		53	14.1		6	1.6
PR /CI 95%	1.23 [0.729-2.095]			0.911 [0.455-1.821]			0.804 [0.382-1.689]			2.92 [0.752-11.400]			0.34 [0.110-1.062]			2.01 [0.416-9.765]
Professional who carried out the PN
Both	58	18.1	0.870^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	46	13.4	0.677^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	46	13.7	0.577^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	6	1.8	0.355^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	45	13.1	0.781^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	7	2	0.657^# * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Nurse	8	21.6		7	17.9		4	10.8		2	5.4		5	12.8		0	0
Physician	8	18.6		7	16.3		8	18.6		1	2.3		4	9.3		1	2.3
Risk stratification at admission
High risk	15	25	0.187^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	17	26.6	0.002*	13	20.6	0.088^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	2	3.2	0.627^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	14	21.5	0.026*	0	0	0.611^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
Normal risk	63	17.8		45	12		46	12.6		7	1.9		43	11.5		8	2.1
PR /CI 95%	1.40 [0.859-2.298]			2.21 [1.355-3.617]			1.63 [0.940-2.851]			1.65 [0.352-7.788]			1.878 [1.092-3.232]			1.02 [1.007-1.037]
Delivery at maternity of residence
No	42	21.5	0.185^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	38	18.4	0.017*	32	15.9	0.235^* * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	6	3	0.318^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.	34	16.3	0.047*	4	1.9
Yes	36	16.4		24	10.4		27	11.9		3	1.3		23	10		4	1.7	1.000^** * Pearson Chi Square; ** Fisher Exact Test; #Likelihood ratio; PR = Prevalence Ratio; CI = Confidence Interval.
PR /CI 95%	1.31 [0.877-1.957]			1.76 [1.098-2.842]			1.33 [0.828-2.144]			2.22 [0.564 – 8.782]			1.642 [1.001-2.693]			1.111 [0.281-4.384]

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[1] Corresponding author: Camila Almeida Neves de Oliveira Av. Dário Rabêlo, 977, Sete de Setembro 63500-000 – Iguatu, CE, Brazil camilaandeoliveira@gmail.com